Physicians have always been concerned with psychiatric patients who find the sick role comfortable and thus difficult to give up. Past research on rates of remission usually centered on "medical" factors that might explain chronicity, for example, the patient's diagnosis, personality or the treatment received. These factors, specific to the individual, have never been strong enough to predict empirically which patients will remain sick. Recently it has become clearer that the patient's family and the treatment system may have a part in such effects. The sociological theory of deviance called "social labeling theory" alerts us to the question asked in this study: What part does the patient's social experience with his family and the treatment system have in sustaining the sick role? We will investigate maintenance of the sick role at two levels. First, we predict that the more comprehensive the psychiatric treatment system (i.e., the more integrated and extensive) and the more credence given to "intrapsychic" explanations of illness, the more likely that patients are maintained in the sick role. We will follow discharged first-admission psychiatric patients from comprehensive and non-comprehensive treatment systems for one year after discharge to measure clinical symtoms and social performance at outcome. Second, we predict that, depending upon relative power and beliefs about illness, certain patient/treatment agent (and patient/family) negotiations serve to discourage the ex-patient from dropping the label of "mental illness" and returning to his normal role. We will measure the process of labeling and de-labeling by following a panel sample of discharged patients throughout the first year after discharge, interviewing treatment people, patients and family at several points in time. A completed pilot study has indicated that these methods will be feasible and that many of the hypotheses are likely to be supported. The goal of the research is to construct an empirical causal model that will show how the ex-patient's social experience with family and treatment systems sustains the label of "illness" and supports clinical symptoms.